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February 2005

Refractive Surgery and Cornea: The Never-Ending Spiral of Technology

Arch Ophthalmol. 2005;123(2):265-266. doi:10.1001/archopht.123.2.265

New technology and improvements in existing technology applicable to refractive, corneal, and cataract surgery continue to come at a dizzying pace—to the point that even the subspecialist at times feels buried beneath a mountain of promising, and often competing, tools. This article highlights a few of the latest developments that have the potential to change the practice of refractive, corneal, and cataract surgery in the United States.

At a recent symposium on technological advances in ophthalmology (American Academy of Ophthalmology Annual Meeting; October 2004; New Orleans, La), Marguerite B. McDonald, MD, highlighted no fewer than 18 new intraocular lenses for use in refractive surgery or cataract surgery that have been recently approved for use in the United States or that are under development. These included phakic, adjustable, and accommodating intraocular lenses. One of these lenses, the anterior chamber lens1 from Verisyse/Artisan (Advanced Medical Optics, Santa Ana, Calif), was recently approved by the Food and Drug Administration and will soon be available to ophthalmologists for phakic patients with refractive errors in the range of -5 to -20 diopters (D). Another phakic intraocular lens, the posterior chamber lens2 from Visian ICL (Staar Surgical, Monrovia, Calif), appears to be nearing approval by the Food and Drug Administration. Phakic intraocular lenses are likely to be especially attractive options for correcting high levels of refractive error, such as myopia greater than -8 to -10 D or hyperopia greater than +3 to +4 D, where corneal refractive procedures such as laser in situ keratomileusis and photorefractive keratectomy are less predictable and more likely to be associated with complications, such as diminished quality of vision, glare, and halos. Disadvantages of phakic intraocular lenses include the inability to correct the astigmatism present in a significant proportion of patients of refractive surgery (although toric lenses are under development and the implantation of a lens could be followed by laser in situ keratomileusis or photorefractive keratectomy correction of astigmatism) and uncertainties about long-term complications such as cataract, glaucoma, and corneal endothelial damage many years after implantation. The Light Adjustable Lens from Calhoun Vision (Pasadena, Calif) is being developed to allow post–cataract surgery adjustment to lens power with polymers that can be activated for adjustment using precisely directed light energy and then permanently fixed with follow-up light. Other intraocular lenses are available or being developed to allow for simultaneous correction of near and distance vision. These include the hinged plate haptic silicone lens from Crystalens (Eyeonics, Alisio Viejo, Calif) and the multifocal intraocular lens from Array (Advanced Medical Optics). We could mention many other lenses, but these examples illustrate the broad range of possibilities for surgeons and patients interested in phakic intraocular lenses and lenses for use in refractive or cataract surgery.

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